Provider Demographics
NPI:1881221265
Name:OGUNTOMI, TOLULOPE ARAMIDE
Entity Type:Individual
Prefix:
First Name:TOLULOPE
Middle Name:ARAMIDE
Last Name:OGUNTOMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SAINT MARYS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-4037
Mailing Address - Country:US
Mailing Address - Phone:301-934-3415
Mailing Address - Fax:
Practice Address - Street 1:1 SAINT MARYS AVE STE 101
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-4037
Practice Address - Country:US
Practice Address - Phone:301-934-3415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR168945363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health